Premier Healthcare Providers, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

PREMIER HEALTHCARE PROVIDERS, LLC

Practice address

3962 Busby Mill CT
Ellenwood, GA 30294-2052

Phone

(404) 314-7295

NPI assigned

Feb 24, 2020

Last updated

Feb 24, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gwendolyn Elaine Montgomery, NPNPI 1629635859

Title

NP

Phone

(404) 314-7295

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gwendolyn Elaine Montgomery, NURSE PRACTITIONER

  • Acute Care Nurse Practitioner
  • Ellenwood, GA
  • NPI 1629635859
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1326672734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3962 BUSBY MILL CT",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942052",
            "telephone_number": "404-314-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3962 BUSBY MILL CT",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942052",
            "telephone_number": "404-314-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTHCARE PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "404-314-7295",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MontgomeryAGACNP@gmail.com",
            "affiliation": "N",
            "address_1": "3962 Busby Mill Ct",
            "city": "Ellenwood",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302942052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.